Authors, country, and year

Design

Time of Study

Participants

Outcome

Measure

Key findings

Families of individuals with no disease and disability

Gadermann et al.

Canada 2021 [16]

Quantitative

(cross-sectional)

During the COVID-19 pandemic (May 2020)

Parents with children aged < 18 years at home (N = 618)

Family Relations

Mental Health

- Ad-hoc items about changes in parent-child relations due to COVID-19

- Ad-hoc items about changes in mental health due to COVID-19 pandemic

- Parents often reported increases in both negative and positive parent-child interactions due to the COVID-19 pandemic.

- Financial concerns, and stress that the COVID-19 pandemic caused mental health problems were related to both negative and positive interactions.

- Parents with children at home were more likely to report deteriorated mental health (44%), and suicidal thoughts and self-harm (8%) since the onset of the COVID-19 pandemic than individuals with no children at home (35% and 2%, respectively).

Gunther-Bel et al. Spain 2020 [17]

Mixed methods

First 3 weeks of the lockdown (Mar-Apr 2020)

Adults aged ≥ 18 years with their partner and/or children (N = 407)

Family Relations

- Dyadic Adjustment Scale (for participants without children)

- Basic Family Relations Evaluation Questionnaire (for participants with children)

- Open-ended question about perceived changes in couple or family dynamics during lockdown

- Participants without children reported comparable levels of couple relationships to the Spanish standardization sample during the lockdown. Participants with children reported comparable levels of parent-child relationships, but reported worse couple relationships during the lockdown.

- Job loss related to COVID-19 and psychological distress had a negative impact on couple relationships among participants without children. Job loss related to COVID-19 had a negative impact, and telecommuting had a positive impact on couple relationships among participants with children.

- In the qualitative data, 59% of participants reported perceived improvement in family relationships, 39% reported perceived deterioration, and 2% reported both, with the family connection and conflict atmosphere cited most often, respectively.

Guo et al. China 2021 [18]

Quantitative (cross-sectional)

During lockdown (Feb 2020)

Non-specific individuals (N = 24,188)

Family Relations

- Ad-hoc items about family closeness including remote and face-to-face communication with family and family activities such as playing games

- Of participants, 63% reported more closeness with their families than before the pandemic (such as in network communication, face-to-face family activities, and playing games), while only 8% reported less closeness with their families.

- Family closeness of participants was increased in areas where COVID-19 was more prevalent. Family closeness of participants with better neighborhood closeness was better than that of participants with worse neighborhood closeness.

Hamadani et al. Bangladesh 2020 [19]

Quantitative (cross-sectional)

During lockdown (May-June 2020)

Mothers or female guardians of children (N = 2417)

IPV Mental Health

- Items based on the WHO multi-country survey tool and specifically addressed emotional, physical, and sexual violence

- Centre for Epidemiologic Studies-Depression Scale

- Generalized Anxiety Scale

- Compared to before the lockdown, more than half of Bangladeshi mothers with experiences of IPV reported that depressive symptoms, and emotional, physical, and sexual violence increased during the lockdown.

- Of participants, 26% reported mild anxiety, 12% reported moderate anxiety, 1% reported severe anxiety, and 99% reported an increase in anxiety symptoms since the onset of the lockdown.

Kracht et al. USA 2021 [20]

Quantitative (cross-sectional)

During lockdown (May 2020)

Mothers of preschoolers (N = 1721)

Physical Health

- Godin–Shephard Leisure-time Physical Activity Questionnaire (physical activity)

- Pittsburgh Sleep Quality Index (sleep disturbance)

- Household chaos and stress were negatively related to physical activity and sleep among mothers of preschoolers.

- Stress partially mediated the association of household chaos with physical activity and sleep among mothers of preschoolers.

Mechili et al. Albania 2021 [21]

Quantitative (cross-sectional)

After first 10 days of lockdown (Mar-Apr 2020)

Bachelor and master nursing students (N = 863) and their family members (N = 249)

Mental Health

- Patient Health Questionnaire-9 (depression)

- Twenty six percent of family members with nursing students indicated moderate to severe symptoms of depression.

- Family members who considered that COVID-19 and quarantine could cause problems on their health, reported elevated levels of depression.

Noguchi et al. Japan 2021 [22]

Quantitative (longitudinal)

Before (Mar 2020) and after (Oct 2020) lockdown

Family caregivers and non-family caregivers who were community- dwelling older adults aged ≥ 65 years (N = 957)

Mental Health

- Items about depression based on a previous study

- Family caregivers were more likely to have the incidence (having no depression symptoms before lockdown, but having them after lockdown) or persistence (having depression symptoms both before and after lockdown) of depressive symptoms than non-family caregivers.

- Caregivers with increased burden during the lockdown experienced higher incidence or persistence of depressive symptoms.

Sit et al. Hong Kong 2021 [23]

Quantitative (cross-sectional)

During COVID-19 pandemic (May 2020)

Adults aged ≥ 18 years with one or more family members (N = 4890)

Family Health Family Happiness Family Relations

- Items about family health, harmony, and happiness based on a previous study

- Ad-hoc items about increase in negative emotions among family members and family conflict

- Fear of COVID-19 was not associated with family happiness, family health, and family harmony, but was associated with increased family conflicts and negative emotions among family members.

Tierolf et al. Netherlands 2021 [24]

Mixed Methods

Before (Jan 2020) and during (Feb 2020) lockdown

Parents aged ≥ 18 years (N = 290) and children aged 3 - 18 years (N = 261) in the same families with high risk of IPV and/or CAN for quantitative study, and parents aged ≥ 18 years (N = 30) and children aged 3 - 18 years (N = 9) in the same families with high risk of IPV and/or CAN, and professionals (N = 13) for qualitative study

IPV

CAN

- Conflict Tactics Scale-2 (IPV)

- Conflict Tactics Scale Child-Parent (CAN)

- Interview about impact of COVID-19 on family safety

- No difference was found in the frequencies and severities of IPV and CAN between families before and during the lockdown, but half of the families had frequent and serious violence (more than 22 incidents of IPV and/or CAN per year, and more than two incidents of mild and/or severe CAN, and/or severe IPV).

- Most families stated that the COVID-19 pandemic often caused stress and tension in the family, further promoting IPV and CAN.

Wong et al. Hong Kong 2021 [25]

Quantitative (cross-sectional)

During COVID-19 pandemic (May 2020)

Adults aged ≥ 18 years with family members (N = 4891)

Family Health Family Happiness Family Relations

- Ad-hoc items about family physical health and family hygiene

- Ad-hoc items about family mental health including family negative and positive emotion, and family happiness

- Ad-hoc items about family relations including family harmony and family’s ability to cope with difficulties

- The prevalence of perceived benefits of COVID-19 on family physical health, mental health, and relations was 19%, 7%, and 14%, respectively. The most common perceived benefits were improved family hygiene in family physical health, increased family positive emotion in family mental health, and increased family’s ability to cope with difficulties in family relations.

- The prevalence of perceived harms of COVID-19 on family physical health, mental health, and relations were 2%, 38%, and 19%, respectively. The most commonly perceived harms were poorer family physical health, increased family negative emotion in family mental health, and decreased family harmony in family relations.

Wong et al. Hong Kong 2020 [26]

Quantitative (cross-sectional)

During COVID-19 pandemic (Apr 2020)

Adults aged ≥ 18 years (N = 1501)

Family Health Family Happiness Family Relations

- Items about family health, harmony, and happiness based on a previous study

- Personal preventive behaviors such as washing hands and wearing mask were positively related to family happiness, family health, and family harmony.

Xie et al. China 2021 [27]

Quantitative (longitudinal)

Before (Mar–Dec 2019) and during (Jan–Aug 2020) COVID-19 pandemic

Pregnant women (N = 2657 before the pandemic and N = 689 during the pandemic)

Family Functioning Physical Health Mental Health

- Symptom Check List-90 Revised (depression, anxiety, and somatization)

- Pittsburgh Sleep Quality Index (Sleep disturbance)

- Family Environment Scale (Family Functioning)

- Pregnant women during the COVID-19 pandemic reported lower levels of family cohesion and higher levels of conflict and independence compared to before the pandemic.

- Pregnant women during the COVID-19 pandemic were more likely to report sleep disturbance, depression, anxiety, and somatization, compared to before the pandemic.

- Family cohesion was a protective factor for depression, anxiety, and somatization, whereas family conflict was a risk factor.

Families of COVID-19 patients and survivors

Beck et al. Switzerland 2021 [28]

Quantitative (longitudinal)

During COVID-19 pandemic (Mar–Jun 2020)

COVID-19 patients after hospital discharge (N = 126) and their closest relatives (N = 153)

Mental Health

- Hospital Anxiety and Depression Scale (anxiety and depression)

- Impact of Event Scale-Revised (posttraumatic stress disorder)

- Of the relatives of COVID-9 patients, 16% had moderate symptoms of anxiety and 15% had moderate symptoms of depression.

- Death of patients and perceived burden due to COVID-19 such as risk of infection and separation from patients were related to moderate symptoms of anxiety and/or depression among relatives.

Mohammadi et al. Iran 2021 [29]

Qualitative (content analysis)

During COVID-19 pandemic (Feb–May 2020)

Family members with individuals who died from COVID-19 (N = 16)

Family Relations Mental Health Social Health

- Interview on experiences of bereavement among family members

- Participants described that death of a family member (especially a father) had a very adverse effect on the stability of the family.

- They felt guilt that they may have transmitted coronavirus to their families and caused the death of their loved ones.

- People were terrified of interacting with the families of COVID-19 victims and would rather stay away from them. They were stigmatized and labeled after the death of their loved family member.

Rahimi et al. Iran 2021 [30]

Qualitative (Phenomenology)

During COVID-19 pandemic (Jun–Aug 2020)

Family caregivers caring COVID-19 patients at home (N = 13)

Family Relations Physical Health Mental Health Social Health

- Interviews on caring experiences of family caregivers

- Caring for a patient with COVID-19 improved the relationship between family caregivers and patients. The experience of living with and caring for patients increased their interest in each other, and they appreciated each other during the pandemic.

- Some family caregivers reported experiencing physical problems such as fatigue, sleep disturbances, anorexia, and allergies caused by overuse of disinfectants. Fatigue and insomnia were the most commonly reported physical symptoms.

- Family caregivers described the COVID-19 pandemic as difficult and terrifying. They experienced fear, anxiety, worry, sadness, hopelessness, and mental preoccupation about patients’ progress, and felt powerless to manage their symptoms.

- Family caregivers encountered negative reactions from healthy people in the community, and felt socially rejected and deprived because healthy people thought that caregivers may be carriers of COVID-19, avoiding to contact them. Moreover, they were home alone with the patient, which made them feel lonely.

Shah et al. Europe and North America etc. 2021 [31]

Quantitative (cross-sectional)

During COVID-19 pandemic (Jun–Aug 2020)

COVID-19 survivors after average 13 weeks since COVID-19 symptoms started (N = 735) and their partners (N = 571) or family members (N = 164) aged ≥ 18 years

QOL

- Family Reported Outcome Measure

- Partners and family members reported that the poor dimension of the Family Reported Outcome Measure measuring their QOL was feeling worried, followed by the dimension of family activities, frustration, holiday, and sex life.

- Partners and family members with a COVID-19 history experienced a greater impact on eating habits, work and study, family activities, holiday, sex life, and sleep than those with no history.

Families of individuals with disabilities

Alhuzimi Saudi Arabia 2021 [32]

Quantitative (cross-sectional)

During COVID-19 pandemic (Jun 2020)

Parents of children with autism spectrum disorder (ASD) aged ≤ 18 years (N = 150)

Mental Health

- Parent Stress Index Short Form (parenting stress)

- General Health Questionnaire-12 (psychological distress)

- Of parents, 94% reported that parenting stress increased, and 79% reported that psychological distress was impacted due to the present COVID-19 situation.

- More severe ASD behaviors in comparison to the pre-COVID-19 status increased parenting stress and psychological distress, while a higher frequency and usefulness of ASD support decreased parenting stress and psychological distress.

Beach et al. USA 2021 [33]

Quantitative (cross-sectional)

During COVID-19 pandemic (Apr–May 2020)

Family caregiver of individuals with physical and cognitive/ memory problems, and behavioral, emotional, or developmental disorder (N = 576) and non-family caregivers (N = 2933)

Physical Health Mental Health Social Health

- Patient-Reported Outcomes Measurement Information System short forms (anxiety, depression, fatigue, sleep disturbance, and social participation)

- Family caregivers reported more anxiety, depression, fatigue and sleep disturbance, and less ability to participate in social activities than non-family caregivers.

- Family caregivers who reported a greater impact of COVID-19 on their caregiving had more anxiety, depression, fatigue and sleep disturbance, and less social participation than family caregivers who reported less impact.

Manning et al. USA 2020 [34]

Quantitative (cross-sectional)

During COVID-19 pandemic (Mar–May 2020)

Individuals with autism spectrum disorder (ASD) aged ≥ 20 years (N = 12) and their family members (N = 459)

Mental Health

- Ad-hoc item about stress in families caused by the COVID-19 restrictions

- Family members of individuals with ASD had high levels of stress caused by COVID-19 restrictions.

- Family members reported the following stressors: worry about an individual with ASD being home all the time (55%), concern about becoming ill or an individual with ASD becoming ill (52%), financial difficulties (31%), worry about lack of care other than myself for an individual with ASD (22%), and separation from an individual with ASD (5%).

- ASD severity increased stress caused by COVID-19 restrictions among family members.

Tsibidaki Greece 2021 [35]

Quantitative (cross-sectional)

Second and third week of lockdown (Mar–Apr 2020)

University students (N = 26) and parents (N = 35) in families with one or more members with special educational needs and disability

Mental Health

- State-Trait Anxiety Inventory (anxiety)

- Parents reported higher levels of state anxiety and resilience, and reported lower levels of trait anxiety than university students.

- Higher levels of self-efficacy and resilience improved state and trait anxiety among both university students and parents.

Families of children with chronic diseases

Alessi et al. Brazil 2021 [36]

Quantitative (cross-sectional)

During social distancing for high-risk group for COVID-19 (May–Jun 2020)

Family caregivers of children with type 1 diabetes aged ≤ 18 years (N = 381) and parents of children without diabetes (N = 383)

Mental Health

- Self-Reporting Questionnaire (mental health disorders)

- Ad-hoc items about pandemic-related emotional burden and diabetes-specific emotional burden related to diabetes care

- The proportion of having mental health disorders during social distancing was higher in family caregivers of children with type 1 diabetes aged < 12 years compared to those of children without diabetes aged < 12 years.

- Family caregivers of children with type 1 diabetes reported more pandemic-related emotional burden compared to family caregivers of those without diabetes.

- Regarding psychological burden related to diabetes care among family caregivers of children with type1 diabetes, 41% reported discontent in care sharing, 36% reported discontent in support, 42% reported discontent in appreciation, 48% reported exhaustion, and 76% reported guilt problems.

Ehrler et al. Switzerland 2021 [37]

Quantitative (longitudinal)

Before (Jan 2013–Mar 2020) and during (Apr–May 2020) COVID-19 pandemic

Parents of typically developing children (N = 73), and children born very preterm (N = 54), and children with congenital heart diseases (N = 73)

Family Functioning

- Family Relationship Index

- Family functioning reported by parents during the COVID-19 pandemic was lower in comparison to before the pandemic, independent of group (parents of typically developing children, and children born very preterm, and children with congenital heart disease) and family socioeconomic status.

- Family cohesion and expressiveness during the COVID-19 pandemic were lower than those before the pandemic, but there was no difference in family conflicts during and before the COVID-19 pandemic.

Zhao et al. China 2020 [38]

Quantitative (cross-sectional)

During COVID-19 pandemic (Feb 2020)

Family caregivers of children with kidney failure on long-term kidney replacement therapy aged ≤ 18 years (N = 220)

Mental Health

- General Anxiety Disorder Scale (anxiety)

- Patient Health Questionnaire-9 (depression)

- Of family caregivers, 11% (15% and 7% of family caregivers of children with dialysis and kidney transplant, respectively) had anxiety symptoms, and 13% (18% and 8% of family caregivers of children with dialysis and kidney transplant, respectively) had depressive symptoms.

Families of workers involved COVID-19 patients

Feng et al. China 2020 [39]

Quantitative (cross-sectional)

During COVID-19 pandemic (Feb 2020)

Family members of front-line rescue workers (N = 671)

Physical Health Mental Health

- Generalized Anxiety Disorder-7 (anxiety)

- Patient Health Questionnaire-2 (depression)

- Primary Care Posttraumatic Stress Disorder Screen for DSM-5 (posttraumatic stress)

- Items extracted from Patient Health Questionnaire-9 (sleep disturbance and suicidal thought)

- Of the family members, 55% reported sleep disturbance, 49% had mild or more anxiety symptoms, 12% reported clinically significant depression symptoms, 10% might have posttraumatic stress, and 8% had suicidal thoughts.

- Family members who were more worried about the safety of front-line rescue workers had sleep disturbance and more posttraumatic stress than those who were less worried.

- Family members who were more worried about physical condition of front-line rescue workers had sleep disturbance and more depressive symptoms than family members who were less worried.

- Family members who were more worried about the supplies of front-line rescue workers had sleep disturbance, more anxiety and depressive symptoms, posttraumatic stress, and suicidal thoughts than those who were less worried.

- Family members who had a greater impact of front-line working on their daily life and caring for children as well as elderly reported sleep disturbance, more anxiety and depressive symptoms, posttraumatic stress, and suicidal thoughts than family members who had less impact.

Ying et al. China 2020 [40]

Quantitative (cross-sectional)

During COVID-19 pandemic (Feb 2020)

Family members of healthcare workers (N = 845)

Mental Health

- Generalized Anxiety Disorder-7 (anxiety)

- Patient Health Questionnaire-9 (depression)

- The prevalence of anxiety and depression symptoms was 34% and 29% among family members of healthcare workers, respectively.

- Risk factors for anxiety symptoms included more time (hours) spent thinking about COVID-19, and whether healthcare workers had direct contact with confirmed or suspected COVID-19 patients; a protective factor included the use of effective protective equipment by healthcare workers.

- Risk factors for depressive symptoms included more time (hours) spent thinking about COVID-19 and longer average working time per week for healthcare workers.